Provider Demographics
NPI:1164523106
Name:CATLETT, ARVIL GLENN (MD)
Entity Type:Individual
Prefix:DR
First Name:ARVIL
Middle Name:GLENN
Last Name:CATLETT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:A
Other - Middle Name:GLEN
Other - Last Name:CATLETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:207 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HODGENVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42748-1559
Mailing Address - Country:US
Mailing Address - Phone:270-358-3829
Mailing Address - Fax:270-358-9350
Practice Address - Street 1:207 W MAIN ST
Practice Address - Street 2:
Practice Address - City:HODGENVILLE
Practice Address - State:KY
Practice Address - Zip Code:42748-1559
Practice Address - Country:US
Practice Address - Phone:270-358-3829
Practice Address - Fax:270-358-9350
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2017-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY21010207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64210107Medicaid
KYD92471Medicare UPIN
KY1367201Medicare PIN
KY00578002Medicare PIN